Cystic pancreatic neoplasms: diagnosis and management emphasizing their imaging features

The incidence of cystic pancreaticneoplasms increased in the past decade, dueto the recent advances in multidetector computedtomography and magnetic resonance imaging;several pancreatic cysts are incidentally encounteredduring diagnostic exams performedfor non-pancreatic diseases. Indeed, cystic pancreatictumors are currently considered relativelyrare, accounting for approximately 10% of allpancreatic neoplasms. Serous cystadenoma,mucinous cystadenoma, intraductal papillarymucinous neoplasms and solid-pseudopapillarytumor represent about 90% of all pancreatic primarycystic tumours.The non-optimal diagnostic preoperative accuracyin distinguishing benign from malignantcystic lesions ensures that up till now there areno well-defined guidelines regarding the managementof cystic pancreatic neoplasms. Imagingfindings often do not allow the diagnosis,because there is a considerable overlap amongthe cystic lesions; the best pre-operative characterizationis obtained by the association of alldiagnostic procedures available. For their differenthistology and behavior, cystic pancreaticneoplasms need to be managed according tovarious factors.In this review, the main elements necessaryfor their management are assessed – radiologicalfeatures, tumour dimensions, patients’ characteristics,the mode of clinical presentation andthe associated oncologic markers. A multidisciplinaryapproach – including gastroenterologists,radiologists and surgeons – should beadopted in order to perform a differential diagnosisand a correct management.